Quality of Life Group/Local STD Testing Disclaimer WAIVER

I acknowledge that I am at least 18 years of age and I am requesting a screening for sexually transmitted diseases and/or

1. A physician will review my screening request, order the test(s), and receive a copy of and release my results. However, Quality of Life Group/Local STD Testing, Inc and/or the ordering physician may deny my request for testing and, if denied, I will be refunded my payments in full.

2. I will provide a blood and urine sample at a Patient Service Center.

3. I am being screened only for the sexually transmitted diseases or infections indicated on the order form, and not for every possible sexually transmitted disease or infection.

4. This testing is for screening purposes only. There is no agreement by Health Quality of Life Group/Local STD Testing, Inc. or the ordering physician to provide medical treatment and/or follow-up care.

5. My screening results will be disclosed by a counselor via telephone before becoming available to me online.

6. If my screening results are positive for certain sexually transmitted diseases, I may be asked to provide my name and address so that my results can be reported to my State’s Department of Public Health. I understand that by law, the Department of Public Health cannot compromise my confidentiality.

7. Although the screening is highly sensitive and specific, a statistical possibility of false negative and false positive.

8. If any of my results come back positive, further tests may be required to confirm the results. Confirmatory screening may generate additional expense.

9. My screening may be unviable or lost, and I may have to be retested.

10. All services and materials provided by Quality of Life Group/Local STD Testing, Inc. are for informational use only. They are not a substitute for the advice, diagnosis and treatment by a qualified physician for diseases or infections that may be detected by the screening.

11. Quality of Life Group/Local STD Testing, Inc., the ordering physician, and other entities involved in the screening process make no express or implied warranties or representations whatsoever with regard to the information provided on the website or the screening results. I further understand that by signing this Waiver, I voluntarily assume any risks associated with the screening process. In addition, I hereby release and hold harmless Quality of Life Group/Local STD Testing, Inc., the ordering physician, the laboratory performing the testing, and any other persons and entities associated with this screening process from any and all claims, rights and causes of action arising from any injury or other damages or the consequences thereof, resulting from or in any way connected with the screening while on the Patient Service Center's premises or otherwise directly or indirectly arising from the transaction conducted through this website. I agree that this Waiver is to be construed under the laws of the State of Illinois and that if any portion is held invalid or unenforceable, the remainder shall, notwithstanding, continue in full legal force and effect.

STD Testing - HIV Testing - Herpes Testing - Gonorrhea Testing
Chlamydia Testing - Hepatitis Testing - Syphilis Testing
Urinalysis Testing - CBC Testing